Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand.

INTRODUCTION: There are many types of intrinsic flaps to cover wound defects on the hand, which have been well described in scientific literature. However, the donor sites are often neglected in such studies. Therefore, we aimed to evaluate donor site morbidity for homodigital island flaps, cross-finger flaps, Foucher's pedicle flaps, and flaps of the dorsal metacarpal artery system (DMCA). MATERIALS AND METHODS: A total of 106 intrinsic flap procedures were performed on 106 patients (16 women, 90 men). The donor sites were retrospectively followed up after an average of 3.4 years by a questionnaire, a Disability of the Arm, Shoulder and Hand score, and clinical examination. Donor sites of different flap types were compared for aesthetic outcome, trophic level, and sensation, including 2-point discrimination, temperature, sharp/dull discrimination, the Semmes-Weinstein monofilament test, pain (visual analog scale), and functionality. RESULTS: In general, primarily closed donor sites showed more favorable results than did grafted donor sites. Satisfaction among patients regarding aesthetics of the donor site was highest in patients who had received homodigital island flaps. Grip strength and pain at the operated hand were very heterogeneous and rather influenced by the primary trauma than the type of flap. Homodigital island flap donor sites demonstrated the best results for 2-point discrimination and sharp/dull discrimination, and those for DMCA flaps in the Semes-Weinstein test. CONCLUSIONS: Overall, intrinsic flaps demonstrated low donor site morbidity with reliable coverage of the defects. Of these, the DMCA (especially after primary closure) and homodigital island flaps seemed to produce the best donor site results.

[The cross-finger flap]. / Der Crossfingerlappen.

OBJECTIVE: Soft-tissue coverage by tissue transposition from a neighboring finger of a palmar (classic cross-finger flap) or dorsal (reversed cross-finger flap) soft-tissue defect of the phalanges. INDICATIONS: Conventional cross-finger flap: soft-tissue defects in the proximal or middle phalanges not suitable for skin transplantation. Reversed cross-finger flap: soft-tissue defects in the dorsal proximal or middle phalanges not suitable for skin transplantation. CONTRAINDICATIONS: Extensive tissue defects crossing the finger joints. Concomitant injuries of the neighboring fingers. SURGICAL TECHNIQUE: Harvesting of an adipocutaneous flap from the dorsum of the finger to the midlateral line, preserving the paratenon of the donor phalanx. Transfer of the flap into the defect of the neighboring finger and coverage of the donor site by full-thickness skin grafting. For the reversed cross-finger flap preparation of a subcutaneous flap with preservation of the peritenon by separating a skin flap from the subcutaneous fat according to the "open book - closed book" technique. Transection of the flap pedicle after 14-21 days. POSTOPERATIVE MANAGEMENT: Immobilization of both fingers until the pedicle is transected. Active and passive physiotherapy exercises after 5-7 days. RESULTS: Uneventful healing in all 18 cross-finger flaps, resulting in an average DASH Score (Disability of the Arm, Shoulder and Hand) of 18 after an average follow-up of 38 months (12-81 months). Twelve results were subjectively judged as "very good" or "good", 16 patients complained about intermittent cold intolerance.